Long-term zidovudine reduces neurocognitive deficits in HIV-1 infection.

OBJECTIVE

To determine the efficacy of zidovudine (ZDV) in preventing decline of neurocognitive functions in HIV-1 infection.

DESIGN

Retrospective evaluation of subjects enrolled in a natural history study. Two analyses were made to evaluate the effect of (1) current ZDV, irrespective of length of treatment and (2) long-term ZDV treatment for at least 1 year.

SETTING

Subjects were recruited from HIV out-patient clinics.

PATIENTS: HIV-1-seropositive subjects were assigned to one of three groups according to the Centers for Disease Control and Prevention classification: asymptomatic infection (n = 60), symptomatic infection but without AIDS (n = 51), and AIDS (n = 32).

MAIN OUTCOME MEASURES: Standardized neuropsychological and neurophysiological measures [electroencephalogram (EEG) and long-latency evoked potentials].

RESULTS

Long-term ZDV use was associated with improved cognitive performance in subjects with early symptomatic HIV-1 infection and AIDS, compared to subjects in the same clinical stage but without previous ZDV treatment. This was corroborated by neurophysiological evidence of reduced slow-wave EEG amplitude in the ZDV-treated subjects. The advantage of ZDV treatment was evident despite lower immune status in most treated subjects.

CONCLUSIONS

The findings in this natural history study indicate that long-term ZDV treatment may be an effective prophylactic to reduce neurocognitive deficits in symptomatic HIV-1 infection, thereby lowering the risk for developing HIV-1-associated dementia.